Healthcare Provider Details

I. General information

NPI: 1629241385
Provider Name (Legal Business Name): BETHANY JAYNE HUFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY JAYNE MILLS PA-C

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 CAPITAL AVE SW SUITE B
BATTLE CREEK MI
49015-9393
US

IV. Provider business mailing address

3620 CAPITAL AVE SW SUITE B
BATTLE CREEK MI
49015-9393
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6200
  • Fax: 269-979-6201
Mailing address:
  • Phone: 269-979-6200
  • Fax: 269-979-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601005223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: